Michigan Disability Resistance

This behavior pointed to an under recognized problem called self-neglect. It accounts for more calls to adult protective services agencies nationwide than any other form of elder abuse.

Yet efforts to identify and help older people who neglect themselves often collide with Americans’ emphasis on self-determination.

“If someone has decision-making capacity, do they have the right to live in squalor?” asked Dr. XinQi Dong, a researcher at the Rush Institute for Healthy Aging in Chicago. “As a society, we want to respect autonomy and independence.”

In the Texan’s case, “he wasn’t happy that A.P.S. was there, and he denied that he was being exploited,” said Raymond Kirsch, an agency investigator who became involved. “He also denied that he had a drinking problem.”

Grudgingly, he allowed the agency to set up a thorough housecleaning, to start sending a home care aide and to arrange for Meals on Wheels.

But on a follow-up visit a month later, the caseworker found her client markedly deteriorated. His swollen legs now oozed. He’d become personally filthy and was ranting incoherently. She returned with an ambulance and a doctor who determined that the client lacked the capacity to make medical decisions.